Barbara Lakatos, DNP, PMHCNS-BC, and colleagues of the Psychiatric Nursing Resource Service at Brigham and Women's Hospital (BWH) describe the steps they took in managing psychological responses to trauma in the aftermath of the 2013 Boston Marathon attack. They write, "Emotional reactions were dramatic but were eased by the psychological care and education that our patients, their families, and staff received in the first days to weeks after the bombings."

Psychiatric APNs Share 'Comprehensive Response' to Marathon Bombings

Within minutes after the bombing, 39 patients with multiple injuries arrived at BWH's level I trauma center. "The sheer number of patients arriving in the ED simultaneously, with catastrophic blast, burn, and shrapnel injuries was extraordinary even by our standards," Dr Lakatos and coauthors write. "The magnitude of this event and its effect on our hospital required a comprehensive response that would promote resiliency and healing."

Informed by responses to the September 11 attacks and other recent disasters, psychiatric APNs followed a "trauma informed care" framework--designed to emphasize the "strength, resiliency, physical, psychological and emotional care and safety for staff and survivors as they are cared for and recover from injuries." The scope of the Psychiatric Nursing Resource Service within BWH "placed us in an ideal position to take a leadership role in shaping the organization's psychological response to this event," according to the authors.

In addition to tending to the psychological impact on the trauma victims, the psychiatric nursing specialists played a critical role in responding to the needs of the large numbers of family members present at the hospital. "Anxiety and fear were high and we realized that an immediate response to provide family members information and a forum to be heard would prevent an escalation of tension," Dr Lakatos and coauthors write.

Within 24 hours, an "impromptu multi-family support group" was established. "We met in the only room large enough for the group, provided nourishment and invited them to tell us who they were and who they were there to support." Psychiatric APNs informed family members about the physical and psychological care the patients would receive and the range of supports available. Family members were also advised to take care of themselves, so as to be in the best position to help their loved ones when they returned home.

Psychological Support for Staff Is Important Too

"Knowing that the plans of care for patients and their families were in place we were able to focus our efforts on the staff to ensure they received what they needed to continue to provide care," Dr Lakatos and colleagues write. On each unit treating bombing victims, health care providers were provided with mental health information and support. Like the families, staff were encouraged to sleep, eat a healthy diet, and take other steps to promote physical health and emotional wellness. Patients, families, and staff alike were also advised to avoid reminders of the event and limit the number of people in their lives asking them about the trauma and recovery.

As patients began to recover physically, staff received advice in helping to manage the wide range of emotional reactions. "Coaching nurses on what to say to support patients' and families' psychological health was equal in importance to acknowledging the range of emotional responses they would experience while providing care to patients," according to the authors. Staff were offered a wide range of group and individual supports, helping them feel like they were "beginning to return to normal" within a few weeks.

Dr Lakatos and colleagues believe that their experience at BWH has important lessons for hospitals planning their response to mass trauma events. The trauma informed care framework provides an approach to managing the psychological impact of disasters for patients, families, and health care providers alike. They write, "Bringing together key personnel and experts within the organization as soon as possible to respond to the varying degrees of expected and unexpected reactions to trauma ensured there was support provided at every level."

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